中华血液学杂志
中華血液學雜誌
중화혈액학잡지
Chinese Journal of Hematology
2012年
8期
628-631
,共4页
沈文怡%李建勇%洪鸣%张闰%陆化%刘澎%钱思轩%徐卫%仇红霞%吴汉新
瀋文怡%李建勇%洪鳴%張閏%陸化%劉澎%錢思軒%徐衛%仇紅霞%吳漢新
침문이%리건용%홍명%장윤%륙화%류팽%전사헌%서위%구홍하%오한신
足叶乙甙%动员%外周血造血干细胞
足葉乙甙%動員%外週血造血榦細胞
족협을대%동원%외주혈조혈간세포
Etoposide%Mobilization%Peripheral blood hematopoietic stem cell
目的 探讨单次大剂量足叶乙甙(Vp16)静脉注射联合粒细胞集落刺激因子(G-CSF)用于恶性血液病患者自体外周血造血干细胞(APBSC)动员的有效性和安全性.方法 80例恶性血液病患者包括急性白血病(AL)20例、多发性骨髓瘤(MM)23例、非霍奇金淋巴瘤(NHL)35例、霍奇金淋巴瘤(HL)2例,均采用Vp16 1.6 g /m2匀速持续静脉注射10 h,外周血中性粒细胞计数(ANC)降至1×109/L时开始给予G-CSF 10 μg·kg-1·d-1皮下注射,至采集结束.WBC>5.0×109/L时开始APBSC采集,目标值:单个核细胞(MNC)≥6.0×108/kg且CD34+细胞≥2.0×106/kg.患者经预处理后回输自体外周血干细胞.观察动员采集过程中血液学指标变化、采集细胞数量、造血重建时间、不良反应等.结果 足叶乙甙应用后11(7～25) d开始干细胞采集,中位采集次数为2(1～5)次.80例患者中,APBSC动员失败3例,均为急性非淋巴细胞白血病(ANLL)患者;既往其他方案动员自体干细胞失败的6例患者中5例动员成功,1例既往阿糖胞苷动员失败的ANLL-M5患者足叶乙甙动员仍失败;77例患者CD34+细胞中位数为4(1.59～24.68)×106/kg,其中3例患者CD34+细胞未达2×106/kg,但移植后造血顺利重建.对20例AL和23例MM患者采集物行微量残留病检测,未发现采集物残留肿瘤细胞污染.所有患者均良好耐受动员、采集过程.80例患者在干细胞动员过程中,Ⅳ度白细胞减少发生率为36.25%(29/80),感染发生率为23.75%(19/80).结论 单次大剂量足叶乙甙联合G-CSF动员APBSC总体成功率高,不良反应可控,是恶性血液病患者动员采集APBSC安全有效的方案.
目的 探討單次大劑量足葉乙甙(Vp16)靜脈註射聯閤粒細胞集落刺激因子(G-CSF)用于噁性血液病患者自體外週血造血榦細胞(APBSC)動員的有效性和安全性.方法 80例噁性血液病患者包括急性白血病(AL)20例、多髮性骨髓瘤(MM)23例、非霍奇金淋巴瘤(NHL)35例、霍奇金淋巴瘤(HL)2例,均採用Vp16 1.6 g /m2勻速持續靜脈註射10 h,外週血中性粒細胞計數(ANC)降至1×109/L時開始給予G-CSF 10 μg·kg-1·d-1皮下註射,至採集結束.WBC>5.0×109/L時開始APBSC採集,目標值:單箇覈細胞(MNC)≥6.0×108/kg且CD34+細胞≥2.0×106/kg.患者經預處理後迴輸自體外週血榦細胞.觀察動員採集過程中血液學指標變化、採集細胞數量、造血重建時間、不良反應等.結果 足葉乙甙應用後11(7～25) d開始榦細胞採集,中位採集次數為2(1～5)次.80例患者中,APBSC動員失敗3例,均為急性非淋巴細胞白血病(ANLL)患者;既往其他方案動員自體榦細胞失敗的6例患者中5例動員成功,1例既往阿糖胞苷動員失敗的ANLL-M5患者足葉乙甙動員仍失敗;77例患者CD34+細胞中位數為4(1.59～24.68)×106/kg,其中3例患者CD34+細胞未達2×106/kg,但移植後造血順利重建.對20例AL和23例MM患者採集物行微量殘留病檢測,未髮現採集物殘留腫瘤細胞汙染.所有患者均良好耐受動員、採集過程.80例患者在榦細胞動員過程中,Ⅳ度白細胞減少髮生率為36.25%(29/80),感染髮生率為23.75%(19/80).結論 單次大劑量足葉乙甙聯閤G-CSF動員APBSC總體成功率高,不良反應可控,是噁性血液病患者動員採集APBSC安全有效的方案.
목적 탐토단차대제량족협을대(Vp16)정맥주사연합립세포집락자격인자(G-CSF)용우악성혈액병환자자체외주혈조혈간세포(APBSC)동원적유효성화안전성.방법 80례악성혈액병환자포괄급성백혈병(AL)20례、다발성골수류(MM)23례、비곽기금림파류(NHL)35례、곽기금림파류(HL)2례,균채용Vp16 1.6 g /m2균속지속정맥주사10 h,외주혈중성립세포계수(ANC)강지1×109/L시개시급여G-CSF 10 μg·kg-1·d-1피하주사,지채집결속.WBC>5.0×109/L시개시APBSC채집,목표치:단개핵세포(MNC)≥6.0×108/kg차CD34+세포≥2.0×106/kg.환자경예처리후회수자체외주혈간세포.관찰동원채집과정중혈액학지표변화、채집세포수량、조혈중건시간、불량반응등.결과 족협을대응용후11(7～25) d개시간세포채집,중위채집차수위2(1～5)차.80례환자중,APBSC동원실패3례,균위급성비림파세포백혈병(ANLL)환자;기왕기타방안동원자체간세포실패적6례환자중5례동원성공,1례기왕아당포감동원실패적ANLL-M5환자족협을대동원잉실패;77례환자CD34+세포중위수위4(1.59～24.68)×106/kg,기중3례환자CD34+세포미체2×106/kg,단이식후조혈순리중건.대20례AL화23례MM환자채집물행미량잔류병검측,미발현채집물잔류종류세포오염.소유환자균량호내수동원、채집과정.80례환자재간세포동원과정중,Ⅳ도백세포감소발생솔위36.25%(29/80),감염발생솔위23.75%(19/80).결론 단차대제량족협을대연합G-CSF동원APBSC총체성공솔고,불량반응가공,시악성혈액병환자동원채집APBSC안전유효적방안.
Objective To explore the effectivity and safety of single high-dose(HD) etoposide(Vp16) with granulocyte colony-stimulating factor(G-CSF) for mobilization of autologous peripheral blood stem cells(PBSC) in patients with hematologic malignancies. Methods 80 patients of hematologic malignancies including 20 patients with acute leukemia(AL), 23 with multiple myeloma(MM), 35 with non-Hodgkin's lymphoma(NHL) and 2 with Hodgkin's lymphoma(HL) received Vp16(1.6 g/m2) continuous intravenous infusion for 10 hrs on day 1. G-CSF at 10 μg/kg once daily subcutaneous injection began to use on day of ANC lower than 1×109/L and continued until PBSC collection was completed. Autologous PBSC(APBSC) was collected on day of WBC greater than 5×109/L and continuing until the collection goal was met(target value: MNC≥6.0×108/kg and CD34+≥2.0×106/kg). The patients received APBSC after conditioning regimen. The number of the cells collection, time of hemotopoietic reconstruction, adverse effect and so on were observed during the course of stem cell mobilization and collection. Results PBSC was collected on day 11 (range: 7-25 days) of after Vp16 administration with a median collection time of 2(range 1-5). 3/80 patients with AML got stem cell mobilization failure. 5 of 6 patients who failed to mobilize before got successful stem cell mobilization, 1/6 patient with AML-M5 got a second failure after the mobilization of VP16 whose first time's mobilization using Ara-C did not succeed. The median number of CD34+ cells collected in 77 patients who got successful mobilization was 4×106/kg [range(1.59-24.68)×106/kg]. The collection of 20 patients with AL and 23 with MM were got detection for minimal residual disease, no pollution of tumor cells were happened. All patients could tolerate the whole course of stem cell mobilization. 29/80(36.25%) patients got a 4 grade leucopenia, 19/80(23.75%) patients got infection. Conclusion Single high-dose etoposide with G-CSF for mobilization of APBSC has a higher achievement ratio, a controllable adverse effect, a promising hematopoiesis recovery, which is an effective and safe mobilizing regimen for patients with hematologic malignancies.
